The role of energy availability in the induction and reversal of menstrual disturbances in exercising women

Restricted (Penn State Only)
Lieberman, Jay Leonard
Graduate Program:
Doctor of Philosophy
Document Type:
Date of Defense:
April 24, 2018
Committee Members:
  • Nancy Williams, Dissertation Advisor
  • Nancy Williams, Committee Chair
  • Mary Jane De Souza, Committee Member
  • Barbara Jean Rolls, Committee Member
  • Karsten Koehler, Outside Member
  • Joy Lee Pate, Committee Member
  • Energy Availability
  • Menstrual Disturbances
  • Estrogen
  • Female Athlete Triad
  • Exercising Women
The Female Athlete Triad is a medical condition describing interrelated clinical conditions characterized by low energy availability, menstrual disturbances, and poor bone health. A singular focus on the causal role of energy availability in the development of the Female Athlete Triad has overshadowed an exploration of potential factors that moderate the risk for this condition. Moreover, more translational research is needed on the usefulness of a particular method to monitor energy availability to assess risk of exercise associated menstrual disturbances. Whether the underlying physiological mechanisms associated with the induction and reversal of exercise related menstrual disturbances are similar is unclear. Lastly, because key physiological consequences of exercise related suppression of menstrual function are the result of prolonged hypoestrogenism, the accuracy of urinary determinations of ovarian hormones will be assessed. Our results demonstrate that energy availability is indeed an important metric to monitor in active women in order to prevent menstrual disturbances. However, it appears to interact with reproductive maturity such that those with fewer years since first menses are at greater risk for menstrual disturbances during periods of low energy availability. Our results also suggest that the goal for treating women with exercise related amenorrhea should be to increase body fat, not simply increase energy availability. Lastly, the assessment of ovarian function using the analysis of urinary estrogen and progesterone metabolites should include more sophisticated quantitative approaches. In conclusion, our studies advance our understanding of the significance of energy availability and its practical application in relation to menstrual health.